Nutrition and Hemodialysis

While on hemodialysis, it is very important to adjust your dietary intake to achieve optimum health, feel your best and make sure you have enough energy to participate in the activities you enjoy. Because the hemodialysis diet is individualized, it is very important to consult a renal dietitian to ensure your diet includes the right amount of nutrients. A hemodialysis diet typically includes a healthy balance of protein, sodium, phosphorus, potassium, fluid, calories and vitamins and minerals.

Protein

Protein is used to build body tissue like bones, muscles, skin and hair. Protein also helps fight infections and keep your body fluids balanced. When you are on dialysis, some protein is washed out of your blood, therefore your diet must supply the protein needed to regulate body functions plus more to compensate for the amount lost during dialysis. A renal dietitian can determine how much protein a person should have in their daily intake. Good protein sources include:

High Protein Foods

Serving Size
1 serving = 7 grams of protein
8 oz = 1 cup

Beef, pork, chicken, turkey or fish

1 oz

Egg

1

Egg whites or egg substitute

2 oz (¼ cup)

Tuna fish

2 oz (¼ cup)

Meatless vegetable burger

1

Tofu

2 oz (¼ cup)

Sodium

Healthy kidneys remove extra sodium and water through the urine. For people with kidney failure, dialysis is the process that takes care of this for us. Too much sodium in your diet can lead to high blood pressure and extra sodium intake triggers thirst and the need to drink more fluids, which can cause high fluid gains between dialysis treatments. Create a habit of NOT adding salt to your food. Paying closer attention to labels can also help you choose foods with less sodium. Instead, experiment with herbs and spices to add flavor to your meal. Avoid salt substitutes which contain potassium. High sodium foods you should limit include:

  • convenience food: frozen meals, canned or dehydrated soups, packaged entrees
  • processed meat and cheese: lunch meat, American-style cheese, cheese-based dips and spreads
  • fast food: pizza, tacos, deluxe-type hamburgers, french fries
  • snack food: chips, crackers, salted popcorn, pretzels
  • condiments such as: bottled salad dressing, soy sauce, seasoning salts (garlic salt, onion salt)

Phosphorus

Phosphorus is normally balanced by the kidneys. When the kidneys fail, phosphorus can build up in your blood. Over time, this can cause your bones to become weak and break easily. High levels of phosphorus in the blood can also cause calcium to build up in your blood vessels, heart, joints, muscles and skin leading to damage in the heart and other organs. The most concentrated sources of phosphorus are dark colored carbonated beverages and commercial iced tea, followed by dairy products and some dried cooked beans. However, the phosphorus in dried cooked beans is absorbed less and seldom requires restriction when eaten as one protein serving per day. To restrict phosphorus, follow these guidelines:

High Phosphorus Foods

Serving Size
8 oz = 1 cup

Dairy products and milk substitutes
1 serving daily

2 oz (¼ cup) cheese
3 oz (.375 cup) soy cheese
1½ cups ice cream
8 oz (1 cup) milk
8 oz (1 cup) yogurt

Dried cooked beans
1 serving daily

½ cup cooked

Note: Avoid dark carbonated sodas like colas, Pepsi, Dr. Pepper and bottled or canned iced tea.

Potassium

Potassium is a mineral found in most foods. The main sources are fruits, vegetables and their juices as well as milk and yogurt. In the body, potassium helps muscles and nerves work right, especially the heart muscle. If your potassium level gets too high, muscles become weak, which in turn may cause the heart to slow down and possibly stop beating. When the kidneys fail, they can no longer keep the potassium level in the blood from becoming too high. To avoid high potassium, you should limit the amount of potassium in your diet. Follow these guidelines to limit potassium:

Food Group and Suggested Servings

Serving Size
8 oz = 1 cup

Fruit-
2 portions daily

1 small fruit or ½ large
½ cup canned fruit
½ cup fruit juice

Vegetables and starches
3 portions daily

1 cup fresh
½ cup cooked
½ cup dried cooked beans (once per day)
½ potato

NOTE: Avoid salt substitutes, wasabi or herbal supplements which can be high in potassium. Review these with your doctor or dietitian.

If your potassium remains high, you may need to restrict more foods in your diet.

Fluid

Fluid is often limited while on hemodialysis. The fluid you are allowed depends on your urine output, the amount of salt (sodium chloride) you eat and how long you dialyze. Consuming large amounts of salt will make you thirsty, so controlling your salt intake is the best way for you to control your fluid intake. It is normal for you to gain some weight between dialysis treatments through fluid weight. For most people an acceptable weight gain between dialysis treatments is 2-5% of your estimated dry weight. Higher fluid gains can cause fluid around your lungs, shortness of breath, high blood pressure, chest pain, a weakened heart muscle, swelling in your ankles and feet and cramping during dialysis. Fluids are counted as anything liquid at room temperature including:

  • cocoa
  • ice cream
  • coffee
  • Jello
  • juice
 
  • popsicles
  • liquor
  • sherbet
  • milk
  • soup
 
  • ice
  • shakes
  • soda
  • tea
  • water
 

Calories

It is important to eat enough calories to provide your body with enough energy to stay at a healthy weight, be active, do daily tasks and keep your body from breaking down protein to use as energy. If you are not eating enough calories and need to gain weight, you may add the following foods that are lower in sodium, potassium and phosphorus to your diet.

High calorie foods to include:

Non-diabetics may use:

  • olive and canola oil
  • soft tub margarine
  • homemade gravies and sauces
  • sour cream
  • unsalted crackers and pretzels
  • unsalted popcorn
  • bread, bagels, rolls
  • rice
  • pasta
  • hot or cold cereal (avoid varieties with nuts and dried fruit)
  • angel food cake
  • sherbet
  • animal and graham crackers
 
  • pastries
  • plain cake and cookies
  • vanilla wafers
  • apple or berry pie
  • sugar
  • jam
  • syrup
  • mints, gum drops, jelly beans
  • non-dairy whipped topping
 

Vitamins and minerals

Special renal vitamins are prescribed to dialysis patients, which contain water-soluble vitamins such as B1, B2, B6, B12, Folic Acid, Niacin, Pantothenic acid, Biotin and Vitamin C. Renal vitamins provide just the right amount of these water-soluble vitamins to prevent deficiencies. Please notify your kidney doctor, dietitian or pharmacist if you are taking an over-the-counter vitamin, mineral supplement or herbal supplement. Taking too much of certain vitamins and minerals can build up in the body and are harmful to dialysis patients.

It is important to take your renal vitamin every day after dialysis or at least two hours before dialysis to receive the best results.